Medications For Increased HairAlthough hirsutism shows on the skin, it is started by hormones in the blood. It is therefore as much an internal as external condition. Treatment directed at the hormonal cause can be quite effective. Several of these treatments have been in use for many years but are not widely known. Most of the prescription medications are FDA approved for other indications but not for hirsutism. They can be prescribed for hirsutism however.

The following is meant as general information. What treatment is suitable for an individual must be worked out with a physician.

Proper treatment depends on hormone levels. It generally involves two components:
1) Lowering the level of free testosterone. Oral contraceptives (OCs) are often used for this since some will lower free testosterone by about half. However by themselves, OCs help only slightly. They slow hair growth rates but not down to normal. Some specific oral contraceptives seem to be better than others for hirsutism and related problems. OCs work best when combined with the next form of medical treatment:

2) Blocking the effect of testosterone on the hair follicle. Several medications have this effect. Here are some of the most often used:

Spironolactone The medication most commonly used to block testosterone is spironolactone (Aldactone®) but it must be used in the proper dose. Originally introduced for treatment of high blood pressure, spironolactone is probably now more often used for hirsutism. Doses for hirsutism are higher than those for high blood pressure. Spironolactone can cause menstrual periods to come closer together but combined use with an OC will usually keep the cycle regulated. Because it is a diuretic (water pill) spironolactone can cause slight dehydration. Signs of this include mild fatigue and dizziness but this can be almost always be prevented by adequate water intake.

Finasteride (Proscar® and Propecia®) Finasteride is sold in different doses under the brand names Proscar ® and Propecia® for prostate enlargement and male pattern baldness respectively. This medication blocks the enzyme 5 alpha-reductase which converts testosterone to its more active form, DHT (dihydrotestosterone). DHT is the hormone responsible for the gradual enlargement of the prostate which occurs in most men beyond the age of fifty. A form of this same enzyme is active in the hair follicle and plays a role in both increased hair and loss of hair from the scalp. We know this because people with a rare inherited condition of deficiency of this enzyme have scant body hair. Unfortunately, the males with this rare condition also have abnormal genital development.

Finasteride seems to have some effectiveness for hirsutism though it may not be quite as effective as spironolactone. (It probably can also help alopecia but this is discussed in the article on hair loss.) However it does not have the common spironolactone side effects of increased water loss and more frequent periods.

Risks of finasteride There is a major problem which greatly limits use of finasteride in women. I pointed out that men with a genetic defect in 5a-reductase — the same situation as finasteride creates — are born with abnormalities in their genitalia. This is because the a male baby needs full levels of DHT for his genitalia to form properly during fetal development. The fear is that if a woman takes finasteride when pregnant with a male child, genital abnormalities may occur. This has not been reported in humans but remains a grave concern nonetheless. The labeling for finasteride includes warnings that it should not be taken by women. This is because of the birth defect concern.

Finasteride has been used for hirsutism and alopecia in women, usually those who cannot become pregnant — because they have gone through menopause or had a tubal ligation or hysterectomy. Use of finasteride by women is a decision which needs to be thought through carefully with the input of a knowledgeable physician and reliable means for prevention of pregnancy.

Actually, there are similar concerns about any anti-androgen and any women who takes such medications must be aware of this and take suitable precautions not to become pregnant.

The Cream for Facial Hair There is a new medication, Vaniqa® (eflornithine) which is FDA approved for treatment of facial hair. It is applied twice a day and works by slowing the metabolism of the hair follicle. It does not eliminate the hair but simply slows its growth. I was involved in its development and many women are happy with it. The thing to remember is that it is basically for women who are removing hair. By slowing down how quickly it regrows, Vaniqa can decrease how often hair needs to be removed and make a woman more confident that her secret will not be apparent a few hours after removal. It can be combined with other medications.

How long does it take to see improvement? Because hair growth changes slowly, treatments to alter it work gradually. Though improvement can begin to show within the first 3 or 4 months, it is after that the difference starts to become more and more apparent. It does take patience but most women are happy with the result if treatment is done properly. A regimen customized to a woman’s individual hormonal pattern is much more likely to produce a satisfying result.

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